The brutal reality of Pakistan’s ongoing battle against polio is grimly illustrated by the tragic incidents of September 12, 2024. A policeman was killed while guarding polio workers in Bannu, and a female polio worker was raped in southern Pakistan. These horrific events are not isolated incidents; they represent a disturbing trend of escalating violence and mistrust that threatens to derail the country’s public health initiatives.
Pakistan’s struggle with polio is inextricably linked to the violence directed at healthcare workers. In Khyber Pakhtunkhwa, the epicenter of many attacks, militants have repeatedly targeted polio vaccination teams, spreading the false narrative that the campaign is a Western conspiracy to sterilize Muslim children. This dangerous myth, perpetuated for over a decade, has deeply influenced public perceptions, transforming vaccination efforts into a perilous undertaking for health workers.
The attack in Bannu, where a policeman protecting polio workers was tragically killed, echoes numerous other assaults. Just a day earlier, gunmen claimed the lives of two others – a polio worker and a police escort. This constant threat of violence has created a climate of fear among health workers, making their job incredibly challenging and dangerous.
The militant group Islamic State (IS) claimed responsibility for a roadside bombing in South Waziristan on September 9, which targeted officers protecting a polio team, injuring six officers and three civilians. This recurring pattern of attacks highlights the intensifying assaults on vaccination teams by violent actors.
The rape of a female polio worker in Sindh further exemplifies the vulnerability of healthcare workers. Women have played a pivotal role in Pakistan’s polio eradication campaign, often able to access households that male workers cannot. However, the assault in Jacobabad underscores the risk faced even by these essential female workers. This act of sexual violence against a female healthcare worker, while rare, represents an especially heinous dimension of the threats they face.
Despite decades of concerted efforts, Pakistan remains one of only two countries where polio is endemic, the other being Afghanistan. In 2024 alone, Pakistan has reported 17 new cases of wild poliovirus (WPV1), with the first case in Islamabad in 16 years serving as a sobering reminder that the disease still persists, even in areas previously considered polio-free.
One of the key factors contributing to polio’s persistence in Pakistan is the low vaccination rate in regions like North Waziristan, a former Taliban stronghold. This area, along with Balochistan, has witnessed a resurgence of polio cases due to both direct violence against health workers and the widespread dissemination of misinformation. Local populations, heavily influenced by religious extremists, often resist vaccinations out of fear of retribution from militants or based on unfounded conspiracy theories.
Compounding these challenges are the systemic issues within the public health infrastructure. The National Emergency Operations Centre and government officials have been working to expand outreach efforts. A recent large-scale vaccination campaign launched in September 2024 aimed to reach 33 million children across 115 districts. However, despite these efforts, environmental samples continue to show the presence of the poliovirus, indicating gaps in coverage and the need for more effective strategies.
One of the most damaging episodes in the history of polio eradication in Pakistan is the fallout from the CIA’s fake vaccination campaign during the hunt for Osama bin Laden. In 2011, the American intelligence agency conducted a phony vaccination drive to gather DNA samples from Bin Laden’s family. Although the operation successfully confirmed the Al Qaeda leader’s presence in Abbottabad, it had far-reaching consequences for Pakistan’s health campaigns. The event fueled conspiracy theories that the polio vaccine was a tool for Western intelligence agencies, leading to widespread mistrust of vaccination campaigns.
The aftershocks of this event still resonate today. Militants exploit these fears, framing polio campaigns as foreign plots. In some cases, community members are pressured into avoiding vaccines to protect themselves from potential violence. In extreme cases, parents forge fake vaccination records to avoid both the wrath of militants and government-imposed restrictions. This dynamic has significantly hampered eradication efforts, particularly in conservative rural areas like Khyber Pakhtunkhwa and Balochistan.
While international agencies have provided crucial funding and expertise, their dominant presence in Pakistan’s polio eradication program has often been met with suspicion. The absence of local leadership in such a culturally sensitive initiative has exacerbated the perception that the program is imposed from the outside. This imbalance between international and local input has made it harder to gain community trust.
As Rana Jawad Asghar noted in The Lancet, the program must be adapted to local realities with more significant involvement of Pakistani public health experts and community leaders to ensure its success. In regions like North Waziristan, where polio vaccination rates are dismally low, local public health officials who understand the socio-cultural dynamics have successfully initiated programs that are better accepted by the community. By providing epidemiological training to local health workers, initiatives such as the National Stop the Transmission of Polio program have helped bridge the gap between communities and vaccination efforts.
The broader issue of violence against healthcare workers in Pakistan extends beyond polio campaigns. According to the Safeguarding Health in Conflict Coalition (SHCC), incidents of violence or obstruction against healthcare workers more than doubled between 2021 and 2022. These violent attacks not only claim lives but also disrupt essential health services. In 2022, eight security personnel assigned to protect healthcare workers were killed and 15 were injured in the line of duty, contributing to a culture of fear among vaccinators.
Polio workers often refuse to work in high-risk areas without security escorts, but even then, attacks continue. This has had a devastating impact on the vaccination campaign’s efficacy. In several instances, fear of attacks has led to the suspension of vaccination drives, leaving children vulnerable to preventable diseases like polio.
To combat the twin threats of violence and misinformation, Pakistan’s polio eradication efforts must undergo significant reforms. First, the government must enhance its security measures for healthcare workers. While military escorts are a common practice, they are not foolproof. A more sustainable approach would involve engaging local communities, particularly tribal elders and religious leaders, to foster trust and provide safe passage for health workers. This community-centric model has shown promise in areas like North Waziristan.
Second, there must be a concerted effort to counter misinformation. The government and non-governmental organizations must leverage media campaigns, religious endorsements, and educational programs to dispel myths about the polio vaccine. These initiatives should be tailored to address the specific concerns of rural populations, such as fears of Western conspiracies or religious objections to vaccination.
Finally, the international community, while continuing to provide technical and financial support, must take a backseat in strategy formulation, allowing local health experts to take the lead. By empowering local leaders and integrating their knowledge into public health campaigns, the program can gain greater acceptance within communities.
Pakistan’s fight against polio is not just a battle against a disease; it is a struggle for trust, safety, and the well-being of future generations. The success of this crucial public health mission hinges on effectively addressing the underlying issues of violence, misinformation, and mistrust. Only by fostering collaboration between the government, local communities, and international partners can Pakistan hope to finally eradicate this debilitating disease and secure a healthier future for its children.
